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Washington, D.C. – 149 Members of Congress, led by Representatives Barbara Lee (CA-13), Lloyd Doggett (TX-35), Michelle Lujan Grisham (NM-1), Ted Deutch (FL-22), Pramila Jayapal (WA-7), and Marc Veasey (TX-33), sent a letter to Secretary Tom Price, requesting an explanation for the decision to unexpectedly cut short the Teen Pregnancy Prevention Program (TPPP) project period from five to three years.

Rebecca Cooney

North American Executive Editor for The Lancet | @BekRx

Over $200 million of federal funding for teen pregnancy prevention programs was unexpectedly cut by the Trump Administration in July 2017, leaving researchers and program administrators looking for answers and struggling for continuity.

In a new podcast, The Lancet’s United States of Health Blog spoke with Dr. Christine Dehlendorf, Jenifer DeAtley, and Representative Barbara Lee (D-CA). The following is an edited transcript.

In the last 25 years, we’ve seen a precipitous decline in teen pregnancy in the US. According to data from the Guttmacher Institute, the teen pregnancy rates peaked in 1990, but has declined since—both at the national level as well for each state. Importantly, some of the biggest reductions in birth rates have been observed in black and Hispanic girls ages 15-19. The declines in the rates of teen pregnancy can largely be attributed to more widespread use of contraceptives. And driving the greater use of contraception by teens has been access—access to contraceptives and access to information.

Christine Dehlendorf: Teens definitely have very active and energetic social networks that are Influential on their behavior and their healthcare decision making. And so I think that any interventions designed to optimize their reproductive health needs to take into account the fact that they are part of this social context and can use that social context to benefit them and to help disseminate information that can help them make good quality decisions about their reproductive health.

Sustaining that progress requires concerted efforts. In 2010, the Obama Administration established the Teen Pregnancy Prevention (TPP) Program under the auspices of the Office of Adolescent Health. The TPP program has been dedicated to using evidence-based interventions to prevent teen pregnancy as well as sexually transmitted infections and risky behaviors. In addition to implementing teen pregnancy prevention programs, the TPP also funds training and capacity building, technology, and evaluating these approaches.

Earlier this year, Congress authorized $101 million for the TPP program as part of the FY 2017 funding bill. Yet in mid-July reports surfaced that grantees, the majority of whom have 5-year grant-funded projects, were receiving letters from the Department of Health and Human Services (HHS) notifying them that the project periods were being shortened anywhere from 1-3 years early—effectively pulling the funding for 81 projects to the tune of $214 million.

One of the programs that Dr. Dehlendorf is involved in is subject to these cuts.

Christine Dehlendorf: Our project is called Speak Out, and it's a project designed to help teens get accurate information about long acting reversible contraceptive methods through their social network. We know that teens rely on their social network to get access to information, and often consider information from their peers to be more trustworthy than through conventional medical pathways.

We also know that teens have misconceptions and lack of knowledge about some of the most highly effective contraceptive methods, specifically IUDs and contraceptive implants. The goal of our project Speak Out is to encourage teens who are using one of these highly effective methods to the extent that they feel comfortable, tell their friends about why they chose those methods, and to give their friends information about the methods, and also information about how to access those methods if they want to have them.

The idea is to leverage these social networks and the social communication that we know is already happening to help teens to get good information that allows them to make decisions about their reproductive health and specifically their contraceptive choices in ways that reflect their own needs and don't reflect misconceptions or lack of knowledge.

We're in a position now where although we've been recruiting participants for many months, we are going to have to cut our data collection short, and therefore will not be able to get a sample size that will give us information that will have adequate power to provide helpful information about the impact of our project. Essentially what this means is that instead of having a rigorous, evidence based evaluation of Speak Out, we are going to have nothing more than a feasibility study. This is a huge loss of the invested resources that the federal government has put into our project when we were on track to be able to get important, actionable information about the impact of this on teens’ reproductive health.

Grants administered through research institutions are not the only ones to be affected.

Jenifer DeAtley is the country director for the US programs office of EngenderHealth, a nonprofit focusing on women’s health, sexual and reproductive health, and family planning. She describes how they were notified about the cuts.

Jenifer DeAtley: We had been expecting a continuation of our grant funds. Each of our, the projects that fall under the TPP Program out of the Office of Adolescent Health. We have what's called a cooperative agreement and usually those are a five year agreement. So we have actually in my office, with the EngenderHealth, we have two programs that were currently being funded under the office of adolescent health and were under the impression that those grants would continue into the next fiscal year, which began on July 1st this year. On July 5, we received a letter from the director of Office of Adolescent Health stating that one of our programs in particular, which provides capacity building to youth serving organizations around the country who are running teen pregnancy prevention programs, that that program was going to be cut, effectively immediately.

What was alarming about the letter is that we were already expecting that this funding was going to be continued. We were given indication from our project officers that we were going to be funded. Getting this letter was quite disturbing because it was an effective immediately. There was no close out plan, no wind-down plan. It was just notice that the teen pregnancy prevention program was not a priority at the administration anymore.

What’s behind this decision?

In June, the Trump Administration installed Valerie Huber as the chief of staff to Don Wright, assistant secretary of HHS, whose office oversees the Office of Adolescent Health. Huber is a longtime abstinence advocate. Additionally, HHS secretary Tom Price, opposes federal funding for birth control. So it is not a surprise that the administration is antagonistic to programs like TPP. However, the decision to pull the funding was made without explanation and in the absence of Congressional approval—a fact which is not sitting well with many Congress people.

Representative Barbara Lee, a Democrat from California’s 13th congressional district, is spearheading efforts to get answers from HHS about this controversial decision

Rebecca Cooney: In terms of leading the charge on responding to this decision, you and 148 other members of Congress have sent this letter to Secretary Tom Price requesting an explanation. Can you tell us a little bit about what happens after that? So there's a public request for information here. What else do you have in store that you and your colleagues plan to help fight this?

Barbara Lee: First, we're waiting on a response from Secretary Price. Sometimes they may or may not respond. Which again, speaks of how horrible this administration is on so many of these issues. When you look at their intention, the present budget's zeroed out teen pregnancy prevention programs. They zeroed it out, it totally eliminated it.

But this speaks volumes as to why scientists and researches and people who are working on these programs, get engaged in the political process because we need them to weigh in with their members of Congress. So we're waiting now for the response to the letter and we're going to keep fighting to try to get this funding restored. But also to get an understanding of why they would do this so we can have it on the record because it is putting young people's health at risk and we've got to try to stop this every step of the way. But it's going to take everybody to help us.

In the past, these issues teen pregnancy prevention, comprehensive sex ed, all of these issues have been bipartisan, and I want to thank everyone who continued to work on these issues because they're very important and these grants are grants that I'm going to keep fighting to preserve. And we just have to make sure that everyone circles the wagons now. And just to speak out. We can't just sit on the side lines and do our work and not really engage in letting the Congress, the House members and Senate members, know how this is going to affect their work. And so you have got to really get engaged and we're going to continue to fight in the Congress but people, it's got be an inside–outside strategy.

In the meantime, organizations like EngenderHealth are looking to find ways to establish continuity, where possible, for programs like Re:MIX, a school-based peer education program that focuses on sexual health and forging healthy relationships.

Jenifer DeAtley: That's been one of our biggest concerns because while we are working diligently to engage our donors and our communities to continue to reach out and support us and the work that we do. When you're looking at it, just in the state of Texas we have an $8.6 million dollar loss of funding so that's a lot of money that needs to be filled into those gaps to continue this work. It's not going to sustain everybody. For one of our programs, the Re:MIX program, we have lost a few staff because we're now looking at scaling back on the program.

We've got to plan for closeout while trying to find some funding to fill the gaps because even if our study does end like you said earlier, the data's gone. You can't transition how you're going to do a program in the middle of a study because it compromises the settings. We might have to pull back from the study component but what we're really trying to do is rally the community around continuing to serve the youth that we work with.

In addition to obvious consequences like affecting the lives of participants who may depend on studies like these for contraceptive access, the loss of funding to programs mid-project has important implications for the research enterprise in general. It’s a question of research waste. By failing to honor those funding commitments to researchers, we lose data, we lose the trust of participants, and we lose out on knowledge.